Dupuytren's Contracture in Northampton & Corby
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Understanding Dupuytron's Contractures
Introduction to Dupuytren's Contractures
Dupuytren’s Contracture is a progressive hand condition characterised by the thickening and tightening of the fibrous tissue under the skin of the palm. This thickening causes the fingers—most commonly the ring and little fingers—to bend inward toward the palm, making it difficult or impossible to straighten them fully. While Dupuytren’s Contracture usually develops gradually over many years, in some cases, it can progress rapidly and even become painful.
It is a common misconception that the restrictive bands that you see are the tendons, but they are in fact small nodules in the fascia under the skin that overtime can form a continual tight band.
What Causes Dupuytren's Contractures?
The exact cause of Dupuytren’s Contracture remains somewhat elusive, but it is closely linked to an abnormal production and accumulation of collagen, a protein that is a key component of connective tissues in the body. In Dupuytren’s Contracture, this excess collagen forms thick, fibrous cords under the skin of the palm. Over time, these cords tighten and contract, pulling the fingers—most often the ring and little fingers—toward the palm.
Collagen Build up and Its Effects
Normally, collagen is a flexible and supportive structure, but in Dupuytren’s Contracture, the collagen becomes overactive and thickens, losing its elasticity. This transformation leads to the formation of nodules or lumps, which can be felt just under the skin of the palm. As the condition progresses, these nodules can develop into dense cords of fibrous tissue. These cords are the primary culprits in restricting finger movement and causing the fingers to bend inward, a condition known as contracture.
Unclear Triggers
While the mechanism—collagen build up—is well understood, what triggers this abnormal collagen production is not. Researchers believe that a combination of genetic, environmental, and lifestyle factors may contribute to the development of Dupuytren’s Contracture. The following are key risk factors that have been identified:
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Age: Age is one of the most significant risk factors for Dupuytren’s Contracture. The condition is rarely seen in individuals under 40 but becomes increasingly common with age. By the age of 60, the likelihood of developing Dupuytren’s Contracture increases significantly, likely due to the cumulative effects of aging on tissue health and collagen production.
Gender: Men are disproportionately affected by Dupuytren’s Contracture, with the condition occurring up to 10 times more frequently in men than in women. The reasons for this gender disparity are not entirely clear, but hormonal differences and genetic predispositions may play a role.
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Genetics: There is a strong hereditary component to Dupuytren’s Contracture. If a close relative, such as a parent or sibling, has the condition, your risk of developing it is significantly higher. Studies suggest that specific genetic mutations may make individuals more susceptible to abnormal collagen production and deposition.
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Ancestry: Dupuytren’s Contracture is most prevalent among individuals of Northern European or Scandinavian descent. This has led to the condition being nicknamed the "Viking disease." The higher prevalence in these populations suggests a genetic predisposition that has been passed down through generations.
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Social Habits: Lifestyle factors such as smoking and excessive alcohol consumption have been linked to an increased risk of Dupuytren’s Contracture. Smoking is known to affect blood flow and tissue health, which may exacerbate the collagen buildup in the palms. Alcohol’s impact on liver function and tissue health may also contribute to the development of the condition.
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Medical Conditions: Certain medical conditions appear to increase the risk of Dupuytren’s Contracture. For example, individuals with diabetes are more likely to develop the condition, possibly due to changes in tissue health and collagen production associated with high blood sugar levels. Other conditions, such as epilepsy, cirrhosis of the liver, and seizure disorders, have also been associated with a higher incidence of Dupuytren’s Contracture, although the exact mechanisms remain unclear.
Recognising the Symptoms of Dupuyten's Contracture
Identifying the early signs of Dupuytren’s Contracture is crucial for early intervention and management. The condition typically progresses slowly, but in some cases, it can advance more rapidly. Early recognition of symptoms can help in seeking appropriate treatment before the contracture becomes too severe.
Lumps or Nodules
One of the first signs of Dupuytren’s Contracture is the appearance of small, firm lumps or nodules in the palm of the hand. These nodules are usually painless and are often found near the base of the fingers, particularly the ring and little fingers. Although these lumps may not be bothersome at first, they are an early indication that the condition is developing.
Tough Bands
As Dupuytren’s Contracture progresses, these initial nodules may develop into tough, fibrous bands that extend from the palm toward the fingers. These cords of tissue can be felt under the skin and are responsible for restricting the movement of the affected fingers. The cords may gradually become more prominent and tighter, leading to increased difficulty in straightening the fingers.
Contracture
Over time, the affected fingers may gradually lose their ability to straighten completely, a hallmark of Dupuytren’s Contracture. The contracture often starts subtly, with a slight bend in the finger, but as the condition progresses, the fingers may become permanently bent toward the palm. This contracture can significantly impair hand function, making everyday tasks such as gripping, holding, or typing increasingly challenging.
Difficulty Gripping Objects
As the fingers bend inward, the ability to grip and hold objects diminishes. Patients may notice that simple activities, such as shaking hands, holding a cup, or grasping a pen, become difficult. The contracture can also affect fine motor skills, leading to frustration and difficulty in performing tasks that require precision, such as buttoning a shirt or typing on a keyboard.
Recognising the Symptoms of Dupuyten's Contracture
The diagnosis of Dupuytren’s Contracture is typically straightforward and can usually based on a thorough physical examination by a physiotherapist in Northampton. During the examination, the physiotherapist will assess the hand for the presence of hardened knots or thickened bands of tissue in the palm. They will also evaluate the range of motion in the fingers to determine the extent of the contracture.
Physical Examination: The physical examination is a critical part of the diagnostic process. The physiotherapist will carefully palpate the palm to identify any lumps or cords of fibrous tissue. They may also ask the patient to try to straighten their fingers or make a fist to assess the severity of the contracture. The physiotherapist may use specific tests, such as the "tabletop test," where the patient places their hand flat on a table to see if the fingers can fully straighten and touch the surface.
No Special Tests Required: In most cases, no special imaging tests, such as X-rays or MRIs, are required to diagnose Dupuytren’s Contracture. The condition is typically diagnosed based on the physical signs and symptoms observed during the examination. However, in some cases where the diagnosis is unclear or if the patient is considering surgery, further imaging may be used to assess the extent of the contracture and plan the treatment approach.
By recognising the early symptoms of Dupuytren’s Contracture and seeking a prompt diagnosis, patients can explore treatment options to manage the condition effectively and maintain hand function.
Ensuring Optimal Treatment Outcomes
At Team Rehab UK, we emphasise that treatments which are not effective should not continue beyond accepted clinical timescales without further in-depth investigations. We prefer these additional assessments to be conducted by consultant specialists outside our company’s financial interests. This approach ensures we receive an unbiased second opinion, guaranteeing that the care you receive is the most clinically appropriate.
Treatment Options for Dupuytren's Contracture
The treatment for Dupuytren’s Contracture depends on the severity of the condition and its impact on your daily life. In mild cases, where the contracture does not significantly interfere with hand function, treatment may not be necessary. However, if the condition begins to affect your ability to perform everyday tasks, several treatment options are available:
Conservative Treatments
Heat Application: Applying heat to the palms before massage or exercise can help loosen the tight tissues.
Massage: Gently massaging the thickened tissues in the palm may provide relief and improve flexibility.
Stretching Exercises: Regularly performing stretching exercises, such as bending the fingers away from the palm, can help maintain mobility.
Steroid Injections: In some cases, steroid injections into the affected area can reduce inflammation and slow the progression of the contracture.
Collagenase Injection: This enzymatic treatment involves injecting a drug that breaks down collagen into the fibrous tissue. After the injection, the physiotherapist will manually manipulate the area to help break up the corded tissue.
Needle Aponeurotomy: A less invasive procedure where a small needle is inserted into the thickened tissue and manipulated to loosen and break up the contracture. Ultrasound may be used to guide the needle and avoid damage to surrounding structures like nerves or tendons.
SHOCKWAVE (ESWT): Shockwave therapy has been shown to offer very good results in the treatment of Dupuytren's Contracture and is a relatively simple and non surgical/pharmacological option. The machines are very expensive so not all departments/clinics will have one however we are able to offer this facility at our Brixworth rehabilitation centre.
Surgical Intervention
If conservative treatments fail to improve the condition and the contracture significantly impacts hand function, your consultant may recommend surgery. Surgical options include:
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Fasciectomy: This procedure involves the removal of the thickened fibrous tissue causing the contracture. The surgery is usually performed under local or regional anaesthesia and is typically an outpatient procedure.
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Dermofasciectomy: In more severe cases, where the skin is also affected, a portion of the skin may be removed along with the fibrous tissue. A skin graft may be needed to cover the area.
Post-Surgical Care
After surgery, the incision is closed with sutures and covered with a sterile dressing. The hand may be placed in a splint to protect the surgical site and promote healing.
Post-Operative Care and Rehabilitation
Following surgery, proper post-operative care is crucial for a successful recovery. You will be given instructions on how to care for your hand, including:
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Elevation and Ice: Keep the hand elevated for the first few days to reduce swelling. Applying ice over the bandaged area can also help manage discomfort.
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Avoid Smoking: Smoking can significantly slow down the healing process, particularly if a skin graft has been used.
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Rehabilitation Exercises: Once the initial healing phase is complete, a physiotherapist in Northampton will guide you through rehabilitation exercises designed to restore range of motion, reduce stiffness, and strengthen the hand.
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Follow-Up Appointments: Regular follow-ups with your consultant are essential to monitor your recovery and address any complications early.
Potential Risks and Complications of Surgery
As with any surgical procedure, there are potential risks and complications associated with surgery for Dupuytren’s Contracture. These may include:
Infection: Despite sterile conditions, infections can occur and may require antibiotics or additional surgery.
Nerve Damage: There is a risk of damaging nerves during surgery, which could lead to weakness, paralysis, or loss of sensation in the hand.
Arterial Injury: Injury to the arteries of the fingers or hand, though rare, is a serious complication that may require further medical intervention.
Recurrence: Even after successful surgery, there is a possibility that Dupuytren’s Contracture could recur over time.
We have included this video animation to help you visualise the anatomy that we, as professionals, often take for granted. At Team Rehab UK, we are dedicated to helping our patients understand the causes of their symptoms, empowering them to effectively manage their condition both during and after their treatment.
Please note that some of our videos may be of American origin and might contain slightly different professional terms or approaches compared to those used in the UK. However, the content remains highly informative and beneficial. You should seek advice form your UK based specialist before trying any advice contained, or inferred, in the video you ensure it complies with UK best practice standards.
Summary
Dupuytren’s Contracture is a chronic hand condition that can progressively limit the ability to straighten the affected fingers. Early diagnosis and intervention are key to managing the condition and maintaining hand function. Whether through conservative treatments or surgical intervention, the goal is to reduce the contracture, relieve symptoms, and restore as much hand function as possible.
At Team Rehab in Northampton, our experienced physiotherapists are dedicated to providing personalised care for patients with Dupuytren’s Contracture and other hand conditions. We work closely with major insurance providers such as Bupa Northampton and Axa Northampton, as well as welcoming self paying clients, to ensure that you are able to receive the best possible care.
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